Basic Information
| Provider Information | |||||||||
| NPI: | 1558956672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESS OF CONROE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD STE 1400 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2006 S LOOP 336 W STE 500 | ||||||||
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| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773043315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9366473500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2021 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8669318882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.